This article is more than 5 years old. Information may no longer be current.
Research shows metatarsal block is as effective as ankle block for first ray surgery
Investigators found no differences between ankle ultrasound-guided block and metatarsal block, but ultrasound block took 11 minutes longer to perform.
Click Here to Manage Email Alerts
TORONTO — Among patients who underwent first ray surgery under general anesthetic, a metatarsal block proved to be as effective as an ultrasound-guided ankle block for delivering postoperative analgesia, according to results presented here.
“The results of our trial show there is no need for ankle block in patients having first ray surgery and it can also save you time and is equally effective and more efficient,” Sultan N. Qasim, FRCS (Tr&Orth), of University Hospitals of Leicester, United Kingdom, said at the American Orthopaedic Foot and Ankle Society Annual Meeting.
Metatarsal vs ankle block
Qasim and colleagues randomly assigned 25 patients who were undergoing arthrodesis or osteotomy of the first ray to receive an ankle block and 23 patients to receive a metatarsal block. Patients received the ankle block after induction of general anesthesia using ultrasonography, whereas patients received the metatarsal block at the end of the operative procedure. Patients rated their pain level using a VAS at 2 hours, 6 hours and 24 hours after surgery, Qasim said. A physiotherapist who was blinded to the initial treatment recorded patients’ ability to mobilize safely and regain muscle function.
Results showed no statistically significant differences between the two groups of patients based on their pain scores at any time during the study. Researchers also noted there were no differences between the two groups concerning the analysis of their analgesic requirements in the first 24 hours after surgery or in the time it took them to mobilize safely.
Longer time to perform anesthesia
“If you think about it, you would have thought that an ankle block done under ultrasound guidance would be superior in terms of pain relief,” Maneesh Bhatia, MBBS, FRCS (Tr&Orth), who is consultant orthopaedic foot and ankle surgeon at University Hospitals of Leicester, United Kingdom and a coauthor of the study, told Orthopaedics Today Europe. “The patient would like to have that, but the results were on the contrary; that there was no difference in anything.”
Patients who received an ultrasound-guided ankle block required an additional 11 minutes, mean, to have their anesthesia performed vs. the metatarsal block group, according to results.
“The ankle block which is performed is usually done by an anesthetist under ultrasound guidance and, [in] our study, it took about 11 minutes on top of the procedure,” Bhatia said. “You can save that 11 minutes per operation and also you can save the need for the expertise of an anesthetist who specializes in ankle block, etc.,” he said. – by Casey Tingle
- Reference:
- Qasim S, et al. Randomised controlled trial of ankle block vs. metatarsal block for first ray surgery. Presented at: American Orthopaedic Foot and Ankle Society Annual Meeting; July 20-23, 2016; Toronto.
- For more information:
- Maneesh Bhatia, MBBS, FRCS (Tr&Orth), can be reached at University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester LE1 5WW, United Kingdom; email: maneeshbhatia@yahoo.com.
- Sultan N. Qasim, FRCS (Tr&Orth), can be reached at University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester LE1 5WW, United Kingdom; email: drsnqasim@gmail.com.
Disclosures: Bhatia and Qasim report no relevant financial disclosures.